Bioterrorism threat lives on, as do vaccine-related events.

SCOTTSDALE, ARIZ. -- Despite the grateful lull that has followed Sept. 11 and the anthrax scare in 2001, bioterrorism remains a very real threat, a Food and Drug Administration counterterrorism official says.

Dr. Boris Lushniak, the FDA's assistant commissioner for counterterrorism policy and assistant U.S. surgeon general, hopes that vigilance remains active in medical offices and emergency departments across the United States--but frankly, he has his doubts. "I daresay we are going to be caught off guard," Dr. Lushniak said during the Alfred L. Weiner Lecture at the annual meeting of the Noah Worcester Dermatological Society.

A disturbing number of organisms meet all or some of the criteria for an ideal agent of biological terrorism: easy to obtain and work with; inexpensive to produce; able to be widely disseminated; fairly stable in the environment; capable of producing high morbidity and mortality; transmissible person to person; and difficult to diagnose and treat, which would allow an attack to quickly overwhelm the health care system.

On a positive note, the U.S. government has now stockpiled enough vaccine against smallpox to inoculate every man, woman, and child in the country, Dr. Lushniak reported.

Yet, when U.S. public health authorities were notified recently about an individual with suspicious skin lesions on an inbound flight from China, they were unable to find any hospital in a major metropolitan area willing to admit and quarantine the 200 people aboard until danger to the public was ruled out.

Fortunately, in that case, the threat was nullified during 4 hours of frantic planning as the airliner approached U.S. shores, but it stands as a wake-up call about preparedness. "If this is ever to occur, we'd really have to change the way we do our business," he said.

The potential agents of greatest concern--labeled category A by the Centers for Disease Control and Prevention--remain the same as ever: anthrax, smallpox, plague, tularemia, viral hemorrhagic fevers, and botulinum toxin.

The timing could be critical.

Anthrax, for example, can be controlled with antibiotics if it is recognized and treated with postexposure prophylaxis before protein-rich toxins are produced by the organism. "If you can nip it in the spore bud, so to speak, then you really have solved the problem," he said.

Preventive efforts aimed at a potential bioterrorism attack have health implications that physicians should recognize, Dr. Lushniak said.

He described a 2007 case of household transmission of the live virus through a vaccine involving 1 of the nearly 500,000 Americans inoculated against smallpox either through the military or a civilian volunteer program. The active-duty father came into contact with his infant son, who had eczema, within a month of the father having received a smallpox vaccination prior to deployment overseas.

Although the father's vaccine site was covered during the unplanned visit, the child developed a high fever and a generalized papular, vesicular rash that began on the head and neck. Within days, umbilicated lesions covered more than 50% of the child's body and he required mechanical ventilation.

After a course of antiviral and vasopressor medications, intravenous immunoglobulin, and supportive therapy, the child was discharged from the hospital--48 days after admission.

"This ain't real smallpox, people!" Dr. Lushniak said to emphasize the high level of transmission there would be in an actual attack, and the importance of then having a "ring" vaccination strategy aimed at everyone in contact with an exposed subject within 3-4 days.

In the meantime, physicians should be aware of individuals at high risk for vaccine reactions, including pregnant women, patients with skin disorders characterized by epidermal disruption, immunodeficient patients, those with life-threatening allergies or cardiovascular disease, and their household contacts, he said.

RELATED ARTICLE: How Physicians Can Get Involved

* Learn more by going to www.bt.cdc.gov.

* Join the civilian volunteer Medical Reserve Corps and participate in disaster response in your community (www.medicalreservecorps.gov).

* Train and deploy with a National Disaster Medical Assistance Team (www.hhs.gov/aspr/opeo/ndms/teams/dmat.html).

* Join the active reserve corps of the U.S. Public Health Service (http://usphs-ppac.org).

Source: Dr. Lushniak

BY BETSY BATES

Los Angeles Bureau